HTN Urgency/Emergency

Question 1

What is the renin level of most causes of primary hypertension?

Answer 1

Normal

Question 2

Which drug do we want to avoid if you have renal artery stenosis?

Answer 2

ARBs and ACEi and direct renin inhibitor:

but can help preserve renal function in diabetics

Question 3

If you have hx of angioedema do not use these drugs

Answer 3

ACEi and ARBs

Question 4

Do we give ACE or ARB during pregnancy?

Answer 4

no

Question 5

We have HFrEF, what do we not give?

Answer 5

CCB dihydropyridines

Question 6

What do we not give with nondihydropyridine CCBs?

Answer 6

B blockers because too much bradycardia

Question 7

If you have thiazide therapy, what can we give to minimize side effects?

Answer 7

K+ sparing diuretics like amiloride and triamterone

Question 8

Do we want to give loops or thiazides first?

Answer 8

Loops, better

Question 9

A patient has CKD, what do we not give?

Answer 9

K+ sparing diuretics like amiloride and triamterone

Question 10

What do we avoid when giving aldosterone antagonists?

Answer 10

K+ sparing meds/diuretics

Question 11

Preferred agents in primary aldosteronism and resistant hypertension

Answer 11

Aldosterone antagonists like spironolactone and epleronone

Question 12

A patient has HFrEf what do we give?

Answer 12

Bisoprolol and metoprolol

Carvedilol preferred

Question 13

Beta blockers are not first line unless..

Answer 13

ischemic heart disease or heart failure

UNLESS partial beta blockers, do NOT give if you have these (pindolol, acebutolol)

Question 14

Nebivolol induces…

Answer 14

NO induced vasodilation

Question 15

What drugs are associated with orthostatic hypotension?

Answer 15

Alpha-1 blocker, second line agents for benign prostatic hyperplasia

Question 16

Why do we not want to abruptly stop clonidine?

Answer 16

Induces hypertensive crisis, must taper to avoid rebound hypertension

Question 17

This drug is associated with hirsutism and induces pericardial effusion

Answer 17

Minoxidil

Question 18

What drugs are direct vasodilators and what are the side effects associated with this? How do we treat?

Answer 18

Sodium and water retention with reflex tachycardia so use with a diuretic and beta blocker

The drugs are hydralazine and minoxidil

Question 19

What makes HCTZ not effective?

Answer 19

Low GFR

Question 20

What is amiloride used for?

Answer 20

Counteracting K+ loss induced by other diuretics treating HTN or heart failure… however can cause hyperkalemia

Question 21

What rises due to ACEi?

Answer 21

Serum creatinine increases and GFR falls

Question 22

Is ACEi used in pregnancy?

Answer 22

NO, really bad

Question 23

What drops hypertensive vascular remodeling?

Answer 23

ACEi, ARB, CCB

Question 24

This drug causes gingival hyperplasia and pulm. HTN

Answer 24

Nifedipine

Question 25

Explain the difference between nifedipine and verapamil /diltiazem?

Answer 25

Nifedipine binds to inactivated state to keep it from becoming open so it is voltage-dependent so tissues that are more depolarized are more effected like arterial blood vessels Verapamil (inside), diltiazem (outside) are use/frequency dependent because bind to swinging gate so target channels that cycle regularly like myocardium, faster means more block KEY: Nifedipine exerts smaller inotropic effects on the myocardium and no chronotropic effects but larger vasodilatory effects, HR and CO are increased because of reflex SNS

Question 26

What drug can we give to help pass kidney stones?

Answer 26

Tamsulosin, Terazosin

Question 27

What are the side effects of clonidine?

Answer 27

Drowsiness, xerostomia, REBOUND HTN IF DOSE IS MISSED, urinary/sexual dysfunction

Question 28

What is the best drug for gestational hypertension?

Answer 28

Alpha methyldopa

Question 29

What are the 3 toxicities of methyldopa?

Answer 29

Positive Coombs test, SLE syndrome, Bell's palsy

Question 30

Beta blockers cause cold extremities... this leads to the contraindication for?

Answer 30

PVD

Question 31

What are the unfortunate side effects of metoprolol compared to other B1 selective blockers?

Answer 31

CNS effects like lethargy and confusion, nightmares

Question 32

When would we get rebound hypertension with medications?

Answer 32

Alpha 2 agonist or B blocker stopped abruptly

Question 33

Why don't we use B blockers as often now?

Answer 33

Higher risk of stroke and doesn't really help prevent MI

Question 34

What are the 3 drugs that activate the NO/guanylate pathway?

Answer 34

Hydralazine, Nitroglycerin, Nitroprusside

Question 35

What are the 3 syndromes associated with renovascular HTN?

Answer 35

1. Flash PE 2. Progressive renal failure 3. Refractory congestive cardiac failure This all suggest B/L involvement

Question 36

Do we do renal revascularization on patients with stenosis?

Answer 36

Nah, doesn't recover renal function and no better than drugs that block RAS and statin therapy

Question 37

Patient has egg, soy product allergy and lipid issues. What drug do we not give?

Answer 37

Clevidipine

Question 38

Fenoldapam is contraindicated when?

Answer 38

Glaucoma or intracranial pressure is high or sulfite allergy

Question 39

Why is hydralazine not a desirable first line agent?

Answer 39

Unpredictable and prolonged action duration

Question 40

Do not give nitro to...

Answer 40

Volume depleted patients